Yoğun Bakımda Ultrason Uygulamaları: Akciğer Ultrasonu
Özet
Bu makale, yoğun bakım ünitelerinde yatak başı akciğer ultrasonu (US) uygulamalarının önemini ve teknik detaylarını kapsamlı bir şekilde ele almaktadır. Son on yılda kritik hastaların değerlendirilmesinde hız kazanan bu yöntem; santral kateterizasyon, kardiyak performans izlemi, sıvı dengesi takibi ve özellikle plevral efüzyon, pnömotoraks, alveoler-interstisyel sendrom ile akciğer konsolidasyonu gibi pulmoner patolojilerin teşhisinde kritik bir rol oynamaktadır. Akciğer ultrasonu; radyasyon içermemesi, maliyetinin düşük olması, kolay taşınabilirliği ve tekrarlanabilir muayenelere olanak sağlamasıyla geleneksel görüntüleme yöntemlerine karşı önemli avantajlar sunar. Makalede, muayene sırasında kullanılan lineer, konveks ve sektör probların işlevleri ile kumsal işareti (seashore sign), A çizgileri ve B çizgileri gibi temel ultrasonik artefaktların tanımlanması üzerinde durulmaktadır. Tanısal süreçlerde akciğer ultrasonu, plevral efüzyon tespitinde akciğer grafisinden daha yüksek duyarlılığa sahip olup, 5 ml gibi küçük hacimli sıvıları dahi görüntüleyebilmektedir. Pnömatoraks teşhisinde "akciğer noktası" (lung point) gibi spesifik işaretlerin belirlenmesi ve torasentez gibi girişimsel işlemlere kılavuzluk etmesi yöntemin etkinliğini artırmaktadır. Sonuç olarak yazar, gerekli eğitimlerin alınmasıyla akciğer ultrasonunun yoğun bakım pratiğinde vazgeçilmez bir tanı ve takip aracı haline geleceğini öngörmektedir.
This article comprehensively examines the significance and technical details of bedside lung ultrasound (US) applications in intensive care units. Gaining momentum in the evaluation of critical patients over the last decade, this method plays a vital role in central catheterization, cardiac performance monitoring, fluid balance tracking, and especially in the diagnosis of pulmonary pathologies such as pleural effusion, pneumothorax, alveolar-interstitial syndrome, and lung consolidation. Lung ultrasound offers significant advantages over traditional imaging methods due to its lack of radiation, low cost, portability, and feasibility for repeatable examinations. The article highlights the functions of linear, convex, and sector probes used during examinations, along with basic ultrasonic artifacts such as the "seashore sign," A-lines, and B-lines. In diagnostic processes, lung ultrasound has higher sensitivity than chest radiography in detecting pleural effusion, capable of visualizing even small volumes as low as 5 ml. Identifying specific signs like the "lung point" in pneumothorax diagnosis and guiding interventional procedures such as thoracentesis enhances the method's effectiveness. In conclusion, the author predicts that with appropriate training, lung ultrasound will become an indispensable diagnostic and monitoring tool in intensive care practice.
Referanslar
Beaulieu Y, Marik PE. Bedsideultrasonography in the ICU, Part1.Chest 2005;128:881-95.
Beaulieu Y, Marik PE. Bedsideultrasonography in the ICU, Part 2.Chest 2005;128:1766-81.
Belaid B, Mao Z, Qin L, et al. ClinicalReview: Bedsidelungultrasound in criticalcarepractice. Critical Care2007;11:205
Riccardo I, Andrew L, Claudio S. Diagnosticevaluation of therespiratorysystem, Part 23. 2017; 293:308
Kirkpatrick AW, Breeck K, Wong J, et al. Thepotential of handheldtraumasonography in theairmedical transport of thetraumavictim.AirMed J.2005;24:34-39.
Kirkpatrick AW, Nicolaou S, Campbell MR, et al. Percutaneousaspiration of fluidformanagement of peritonitis in space. Aviat Space EnvironMed2002, 73:925-930.
Muradali D, Gold WL, Phillips A, et al. Can ultrasoundprobesandcoupling gel be a source of nosocomialinfectionin patientsundergoingsonography? An in vivoand in vitrostudy. Am J Roentgenol 1995; 164:1521-1524.
Schabrun S, Chipchase L: Healthcare equipment as a sourceof nosocomialinfection: a systematicreview. J HospInfect2006, 63:239-245.
Rutala WA, Weber DJ: Disinfectionandsterilization in healthcarefacilities: whatcliniciansneedtoknow. ClinInfectDis2004, 39:702-709.
LichtensteinDA,Meziere G, Lascols N, et al. Ultrasounddiagnosisof occultpneumothorax. CritCareMed 2005, 33:1231-1238.
Light RW. PleuralDiseases. Philadelphia, PA: Lippincott Williams&Wilkins; 2007.
Kalokairinou-Motogna M, Maratou K, Paianid I, et al. Application ofcolorDopplerultrasound in thestudy of smallpleuraleffusion. MedUltrason. 2010;12(1):12–16.
Lichtenstein D. Lungultrasound in acuterespiratoryfailure an introductiontothe BLUE-protocol. MinervaAnestesiol. 2009;75(5):313-317.
Doust BD, Baum JK, Maklad NF, et al. Ultrasonicevaluationof pleuralopacities. Radiology 1975, 114:135-140.
Soni NJ, Arntfield R, Kory P. Point-of-CareUltrasound. 1st ed. Philadelphia,PA: Saunders; 2014.
Yang PC, Luh KT, Chang DB, et al. Value ofsonography in determiningthenature of pleuraleffusion:analysis of 320 cases. Am J Roentgenol 1992, 159:29-33.
Lichtenstein D, Hulot JS, Rabiller A, et al. Feasibilityandsafety of ultrasound-aidedthoracentesis in mechanicallyventilatedpatients. IntensiveCareMed 1999,25:955-958.
Mayo PH, Goltz HR, Tafreshi M, et al. Safety of ultrasound-guidedthoracentesis in patientsreceivingmechanicalventilation. Chest 2004, 125:1059-1062.
Remerand F, Dellamonica J, Mao Z, et al. Percutaneouschesttubeinsertions: is the” safetriangle” safeforthelung?IntensiveCareMed 2006, 32:S43.
Lichtenstein D, Meziere G, Biderman P, et al. Thecomettailartifact: an ultrasoundsignrulingoutpneumothorax.IntensiveCareMed 1999, 25:383-388.
Lichtenstein D, Meziere G, Biderman P, et al. The “lungpoint”: an ultrasoundsignspecifictopneumothorax. IntensiveCareMed 2000, 26:1434-1440.
Mao Z, Zhi-Hai L,Jian-Xin Y, et al. Rapiddetection of pneumothoraxbyultrsonography in patientswithmultiple travma. Critical Care. 2006; 10:R1 12
Liu DM, Forkheim K, Rowan K, et al. Utilization of ultrasoundforthedetection of pneumothoraxin theneonatalspecial-carenursery. Pediatr Radiol 2003,33:880-883.
Dulchavsky SA, Schwarz KL, Kirkpatrick AW, et al. Prospectiveevaluation of thoracicultrasound in thedetection ofpneumothorax. J Trauma 2001, 50:201-205.
Lichtenstein D, Goldstein I, Mourgeon E, et al. Comparativediagnosticperformances of auscultation,chestradiography, andlungultrasonography in acuterespiratorydistresssyndrome. Anesthesiology 2004, 100:9-15.
Lichtenstein D, Meziere G, Biderman P, et al. Thecomet-tailartifact. An ultrasoundsign of alveolar-interstitialsyndrome. Am J RespirCritCareMed 1997, 156:1640-1646.
Weinberg B, Diakoumakis EE, Kass EG, et al. Theairbronchogram: sonographicdemonstration. Am J Roentgenol986, 147:593-595.
Yang PC, Chang DB, Yu CJ, et al. Ultrasoundguidedpercutaneouscuttingbiopsyforthediagnosisof pulmonaryconsolidations of unknownaetiology. Thorax1992, 47:457-460.
Klein JS, Schultz S, Heffner JE:Interventionalradiology of thechest: image-guidedpercutaneousdrainage of pleuraleffusions,lungabscess, andpneumothorax [seecomments]. AmJ Roentgenol 1995, 164:581-588.
Gehmacher O, Mathis G, Kopf A, et al. Ultrasoundimaging of pneumonia. UltrasoundMedBiol 1995, 21:1119-1122.
